Options for the Management of Chronic Myeloid Leukaemia-1990

The management of the newly diagnosed patient with CML has become more complex in recent years. For the younger patient (aged <50 years) with an HLA-identical sibling allogeneic bone marrow transplantation should be considered and this may be best performed within one year of diagnosis. The probability of cure exceeds 50%. Other patients may be treated conventionally with hydroxyurea (in preference perhaps to busulphan) or with interferon-alpha; the latter drug induces Ph-negativity in some patients but prolongation of life has not yet been proved. Autografting may achieve similar results: some patients autografted in chronic phase achieve long periods of Ph-negativity but the question of whether the procedure prolongs life for any patient is unresolved. Preliminary results of allografting with phenotypically matched unrelated donors suggest that the mortality of the procedure is greater than that of HLA-identical sibling transplants but that some patients will proved to have been cured.